Cardiac Resynchronisation Therapy in Patients with Atrial Fibrillation: Are Results as Good as in Patients with Sinus Rhythm?

摘要

In the last five years, controlled crossover trials and parallel comparisons of cardiac resynchronisation therapy (CRT) to control treatment have convincingly demonstrated symptomatic improvement in patients with severe heart failure and intraventricular conduction disturbances [1-5]. Almost all of these studies were performed exclusively in patients with sinus rhythm. There is, however, evidence from acute hemodynamic and long term studies that atrial fibrillation patients also benefit from CRT.In a catheterisation study, Blanc et al demonstrated a hemodynamic benefit by temporary left ventricular based pacing in 23 patients, six of whom were in atrial fibrillation [6]. These observations were confirmed in a similar acute study by Etienne comprising 10 atrial fibrillation and 17 sinus rhythm patients [7]. In this study, left ventricular pacing and biventricular pacing provided the same benefit concerning pulmonary capillary wedge pressure, systolic blood pressure and mitral incompetence, irrespective of whether patients were in sinus rhythm or atrial fibrillation. These observations underline that ventricular resynchronisation, rather than AV-synchrony, was the explanation for the acute hemodynamic benefit. It is, however, not self-evident that acute hemodynamic improvements imply a long-term benefit.